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Intensivmedizin up2date 2015; 11(04): 293-308
DOI: 10.1055/s-0041-103986
Allgemeine Prinzipien der Intensivmedizin
© Georg Thieme Verlag KG Stuttgart · New York

Therapeutisches Drug Monitoring von Reserveantibiotika

Stefanie M. Bode-Böger
,
Uwe Tröger
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Publikationsverlauf

Publikationsdatum:
09. September 2015 (online)

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Kernaussagen

  • Eine effektive Antiinfektivatherapie ist angesichts fehlender neuer Präparate und zunehmender Resistenzen dringend zu empfehlen.

  • Die große Variabilität der pharmakokinetischen Parameter bei kritisch kranken Patienten erschwert die Dosisvorhersage.

  • Dosisreduktionen sind nicht so häufig erforderlich wie empfohlen. Die Gefahr der Unterdosierung von Antiinfektiva bei septischen Patienten ist zumindest für Betalactam-Antibiotika zweifellos schwerwiegender und häufiger als die Toxizität bei Überdosierung.

  • Die weitere Entwicklung und Implementierung des TDM scheint eine adäquate Methode zu sein, optimale Dosierungen von Antibiotika für den einzelnen kritisch kranken Patienten einzusetzen.

  • Kombinationstherapien bei Carbapenemase produzierenden Bakterieninfektionen scheinen therapeutische Vorteile gegenüber Monotherapien zu haben.

  • Kombinationen mit Carbapenem scheinen wirkungsvoller zu sein als solche ohne Carbapenem, zumindest bis zu einem Resistenzlevel von unter 8 µg/ml.

  • Auch bei einem Resistenzlevel über 8 µg/ml scheint eine Kombinationstherapie mit Carbapenemen und Colistin, Fosfomycin, Aminoglykosiden und Tigecyclin vielversprechend. Dies sollte durch TDM abgesichert werden.

  • Für definitive Empfehlungen müssen Ergebnisse kontrollierter randomisierter Studien abgewartet werden.

 

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